Puerto Rico has had its share of natural disasters in recent years, including Hurricanes Irma and Maria. These hurricanes not only took lives, but they left Puerto Rico without power, without homes, and millions of dollars in property loss. Unfortunately, just as Puerto Rico got back on its feet, the Island got struck with a 6.4 magnitude earthquake on January 6. The earthquake killed one man and left many people without power and no homes. As a board member for InSight Radiology Puerto Rico, a multi-site operator of free-standing radiology facilities, David Joslin has a special connection with the Island and its people. David Joslin shares ways people can donate and help Puerto Rico after the earthquakes.
Donate to Earthquake Relief Funds
David Joslin explains that cash donations go a long way in the earthquake efforts to help Puerto Rico. Those interested in helping the current situation should find a reputable nonprofit and provide donations. For example, the Hispanic Federation Unidos program is a great place to start. This program has partnered with numerous organizations to provide relief for Puerto Rico.
Talk About the Issue
David Joslin mentions that although people born in Puerto Rico are U.S. citizens, they don’t have access to the same disaster relief benefits as the rest of the 50 states. To help Puerto Rico during this time of need, it’s essential to speak out to the local governments and ask for their help.
After the earthquake, many people are without a home, which means they lost access to many of their items. David Joslin says if people are not able to donate cash, they can always send supplies to many relief organizations. These organizations send supplies such as diapers, water, canned foods, garbage bags, toiletries, pet food, and medicines.
Volunteer with Habitat for Humanity or a Similar Organization
As someone who has volunteered for Habitat for Humanity, David Joslin knows the importance of lending a helping hand. Many people who want to help can take a voluntourism trip to improve the area after the earthquakes. The rebuilding process after the earthquakes will take a long time, but giving a helping hand will move the process along.
Donate Frequent Flyer Miles
According to David Joslin, many people don’t realize they can donate their frequent flyer miles. Donating frequent flyer miles to charitable organizations. Many relief organizations can use the miles to fly out volunteers such as doctors or skilled workers to help with the efforts.
A successful senior advisor and radiology consultant, David Kent Joslin, has put together deals for multi-million dollar companies. He has also worked for a variety of healthcare services, management consulting, and software development. David Joslin has a B.A. in history and political science from Duke University and an MBA in finance and accounting from Columbia Business School.
As a healthcare consultant, David Joslin’s job is to advise companies on developing competitive strategies, identify growth, and pursue value-additive mergers and acquisitions. Throughout his career, David Joslin has put together multi-million dollar deals for several healthcare companies. Those familiar with the healthcare industry trends, they have seen an increase in mergers and acquisitions over the past few years. From 2017 to 2018, there was an M&A increase of 14.4 percent. Also, so far, in 2019, healthcare M&As have accounted for transactions that exceed the $11.3 billion.
Most healthcare M&As involved small community-based healthcare centers merging with large regional hospitals. According to David Joslin, when these mergers take place it is usually to guarantee the survival and growth of smaller hospitals. Although M&As in healthcare aim to have a positive impact on employees and the overall business, what effects do they have on patients?
David Joslin explains that the purpose of healthcare M&As is to have a positive impact on the patient. Those in favor of healthcare mergers argue that these transactions mean lower out-of-pocket costs for patients. After a merger, healthcare centers and hospitals have more access to capital, which in turn can lower overall costs for patients. According to the American Hospital Association, healthcare mergers accounted for a 2.5 percent cost reduction between 2009 and 2014, which saved healthcare centers and patients a total of $5.8 million.
Aside from the cost reduction benefits, healthcare mergers also have a positive impact on the quality of the services. In some instances, if a larger hospital doesn’t acquire a local health center, the people in that community can lose access to care. When a healthcare merger happens, the smaller healthcare facility has access to more services. Thanks to the increase in resources and equipment, patients have access to higher quality services. Small practices have the backup and support of large hospitals, which means better care.
Aside from his work as a senior executive consultant in radiology, David Kent Joslin is also a board member of InSight Radiology Puerto Rico, a multi-site operator of free-standing radiology facilities. David Kent Joslin obtained his MBA in finance and accounting from Columbia Business School and a Bachelor of Arts in history and political science from Duke University. He also holds a real estate license in the state of New York. When he is not playing a game of golf, he likes to spend time with his family in their Sarasota home.
In his successful career, David Kent Joslin has worked for a variety of healthcare services, management consulting, and software development. As a successful senior advisor and radiology consultant, David Kent Joslin has put together deals for multi-million dollar companies. David Joslin took on the role of board member for InSight Radiology Puerto Rico, a multi-site operator of free-standing radiology facilities. During his career, David Joslin helped healthcare companies develop competitive strategies and reach success because he always stayed on top of the trends. David Joslin shares the radiology trends that will carry on to 2020.
Similar Challenges Will Continue
According to David Joslin, some of the challenges radiologists dealt with in 2019 will carry on to 2020. As someone who is in the business of radiology, David Joslin sees many of the problems the business faces. For example, referring clinicians often don’t want to cede control to imaging experts. Radiology providers struggle to communicate with patients in a way that makes the most sense for them. Radiologists have the challenge of convincing referring providers that they are the experts.
Continue Rise of Artificial Intelligence
Artificial Intelligence (AI) has been on David Joslin’s radar in 2019 and will continue to be in 2020. In 2020, the imaging industry will revolutionize the way AI enhances MRI, CT, and PET/CT–it will be able to improve the resolution of smaller amounts of data. AI could make it possible to cut MRI imaging time in half. The resolution of PET and CT scans will also improve with the help of AI. David Joslin says this technology is significant because it could help us recognize conditions early and improve the outcome of the treatment.
Decrease of Value-Based Payments
David Joslin notes that in recent years, with changes to healthcare, the radiology industry switched from a fee-for-service business model to a value-based system. Although the value-based system worked for a few years, the trends have changed. In 2020, the shift from value-based payments to the fee-for-service model will become more prevalent in the upcoming months. However, this switch is subject to change based on healthcare industry laws.
Before David Joslin got involved with InSight Radiology, he served as the VP of Operations and Development for RadNet. David Joslin has a B.A. in history and political science from Duke University and an MBA in finance and accounting from Columbia Business School. David Joslin lives in Sarasota, FL, with his family.
As a board member of InSight Radiology Puerto Rico, a multi-site operator of free-standing radiology facilities, David Joslin has first-hand experience in the field of radiology. David Joslin has also built a successful career as a senior advisor and radiology consultant. Throughout his career, David Joslin helped healthcare companies develop a competitive strategy and reach success. Because of his involvement in the industry, David Joslin has identified four key trends in radiology.
According to David Joslin, Artificial Intelligence (AI) is the radiology trend that will break through in 2019. He believes AI will improve MRI, CT, PET/CT by enhancing the resolution of smaller amounts of data. For example, with the help of AI, the MRI imaging time could be cut nearly in half. Also, David Joslin points out, AI will improve the CT resolution and achieve dose reduction for PET/CT. AI is such an important trend in Radiology since this technology can help recognize conditions early and improve the outcome of the treatment.
Although radiology has always been a patient-centered area of healthcare, in 2019 patients are taking more control of their testing. David Joslin acknowledges deductibles have been on the rise for quite some time, which means patients have to pay more out of pocket. As patients have more financial responsibility for the cost of their testing, it makes them more conscious and active in the selection of the provider in terms of where they want to have their tests done and by whom.
Radiologists and Artificial Intelligence Work Together
According to David Joslin, many radiologists felt threatened when AI made an appearance in the radiology sector. However, in order for AI and radiology to make a difference in the field, radiologists are essential, more than ever. Although AI can contribute to new findings in ways that weren’t possible before, radiologists provide the interpretation for the findings. It also means there will be a significant demand for radiologists in the future who cannot be replaced.
Radiologists Take on a New Role
Aside from remaining a key element in radiology, according to David Joslin, radiologists will take on a new role. Because AI and automation will take care of all of the rudimentary tasks radiologists have to deal with, this will give them the opportunity to learn new skills and operated at the high end of their skill set. They will learn to interpret data in real-time, cloud computing, and provide instant recommendations.
About David Joslin
David Joslin graduated from Duke University with a B.A. in history and political science before obtaining his MBA in finance and accounting from Columbia Business School. Before he got involved with InSight Radiology, he served as the VP of Operations and Development for RadNet
As a senior executive consultant in radiology, David Kent Joslin has many years of experience working with various healthcare services, software development, and management consulting. David Kent Joslin is also a board member of InSight Radiology, Puerto Rico, a multi-site operator of free-standing radiology facilities. With his extensive portfolio in the healthcare industry, he explains the healthcare reimbursement process.
Log the Patient Information Necessary to Submit for Payment
According to David Joslin, before they can get paid, medical providers have to log the patient’s information into an electronic health record (EHR). The purpose of the EHR is to document the necessary patient information including, medical history and reason for the visit. Most providers also document how they diagnosed the patient and the treatment plan. It’s necessary that the provider documents all of this information since it’s key to process the reimbursement.
Enter the Appropriate Medical Codes
Every single entry made in the EHR has to have the appropriate medical code. Medical coders or the providers are in charge of assigning medical codes. The use of these medical codes is necessary when trying to obtain reimbursement from payers. David Joslin explains that it’s a lot easier for insurance companies to simply look at the medical code instead of reading through a long medical description. For each service or procedure performed, the provider will be paid based on the services.
Submission of the Claim
David Joslin explains once the services provided to the patient have been properly coded, it’s time to submit the claim. Many providers choose to submit the claim directly to the payer/insurance company, while others first run it through Clearinghouse. According to David Joslin, the purpose of Clearinghouse is to review the claims internally before sending it to providers. If it identifies a mistake, the provider has the opportunity to address it before the payer receives the claim. This cuts back on mistakes and speeds up the reimbursement process. Once the claim is ready to go, the payer will receive the electronic submission.
Wait for the Payer’s Response
Once the payer receives and reviews the invoice, they either pay the full claim, partially pay it, or reject the claim. David Joslin says that providers should also expect a list of remittance advice codes with every rejected claim. On top of providing a code with each rejection, they also provide a brief explanation. The provider needs to take the necessary steps to give the payer what they need in order to process the claim.
Prepare for Audits
Providers should always have all of the documentation necessary in case of an audit. David Joslin explains payers can request an audit at any point to ensure all of the claims are correct. The more organized they are on the front end, the easier the audits will go.
About David Kent Joslin
David Kent Joslin obtained his MBA in finance and accounting from Columbia Business School and a Bachelor of Arts in History and Political Science from Duke University. He also holds a real estate license in the state of New York. When he is not playing a game of golf, he likes to spend time with his family in their Sarasota home.
As a successful senior advisor and radiology consultant, David Kent Joslin has a long successful career in the healthcare industry. For many years, David Joslin has advised companies to help them identify areas that inhibit growth. His role helps healthcare companies develop a competitive strategy and reach success. David Kent Joslin has also worked with a variety of healthcare services, management consulting, and software development. David’s experience with Mergers & Acquisitions healthcare has helped him put together deals for multi-million dollar companies. This is one of the reasons why David Joslin is familiar with the Mergers & Acquisition trends in 2019.
So far, in 2019, healthcare M&As accounted for $11.3 billion in transactional revenue. According to David Joslin, 2018 saw some healthcare M&A trends that carried over into 2019. Small and community-based hospitals and health centers partnered with some of the large regional hospitals. David Joslin explains this move will ensure the survival and growth of the smaller hospitals.
The smaller hospitals were not the only ones merging in 2019. Large and regional healthcare facilities and hospitals participated in mega-mergers to expand their service reach and health coverage. David Joslin also explains that one of the most significant trends includes nonprofit healthcare systems acquiring for-profit health centers and hospitals. By acquiring for-profit hospitals, nonprofits hope to fill service gaps.
Some of the other trends happening in healthcare M&A also have private equity firms accounting for most of the transactions in mega-deals, cross country integrations, and disruptive partnership models. According to David Joslin, the healthcare sectors that have seen the most M&A activity in 2019 include urgent care centers, behavioral health, senior practices, ambulatory surgery, diagnostic imaging, and senior living. For example, David Joslin explains there is a higher need for services that are happening outside of hospitals, which is the reason why urgent care services are a popular sector.
Aside from his work as a senior executive consultant in radiology, David Kent Joslin is also the board member of InSight Radiology Puerto Rico, a multi-site operator of free-standing radiology facilities. David Kent Joslin also has an MBA in finance and accounting from Columbia Business School. Not to mention, he graduated from Duke University with a B.A. in history and political science before obtaining his MBA. He currently resides in Sarasota, FL, with his family. When he is not playing a game of golf, he spends his time building homes with Habitat for Humanity.
Sarasota healthcare consultant, David Joslin, spent all day on September 14th, collaborating with Habitat for Humanity building a home for the future owner, Collette. David said, “We put up zonts and zuckles which support the walls and keep them level when the concrete is poured into their insides.” David Joslin and the team he collaborated with were a few weeks into the project. David Joslin had plans to go back the following Tuesday to continue work on the house.
David Joslin admits this collaboration wouldn’t have been possible without a great organization such as Habitat for Humanity. In the city of Sarasota, Habitat for Humanity is the leading provider of permanent and affordable housing for individuals who qualify. The mission of Habitat for Humanity is to provide income-qualified individuals with the tools and an affordable mortgage to help them improve their living conditions.
Habitat for Humanity wants to facilitate the transition of individuals from tough housing situations to a safe place to live they can call their own. David Joslin and Habitat for Humanity believe improving living situations will help families rise and finally find stability. Staying true to their mission, Habitat for Humanity purchases land to build homes for income-qualified individuals. All of the homes they build have green and sustainable materials, which means the homes meet environmental standards and keep the costs low for homeowners. Habitat for Humanity also provides owners with low rate mortgages, which increases the benefits.
At the end of the fiscal year for 2018, Habitat for Humanity Sarasota had made a difference in the lives of over 22 families. This gave over 34 children a permanent and stable home to grow up. Habitat for Humanity also estimates and increase of 82% from the previous year. David Joslin joined the over 717 volunteers who spent a total of 17,176 hours to make the dream of many families possible. Aside from hundreds of volunteers who donate their time, Habitat for Humanity received over $1.86 million from the over 477 donors.
When he’s not building homes with Habitat for Humanity, David Joslin works as a successful senior healthcare advisor. He advises companies on competitive strategy, growth initiatives and the pursuit of value-additive mergers and acquisitions. He has worked with investment banks and top tier consulting firms in New York, London, Mexico City, and Puerto Rico. David Joslin obtained an MBA from Columbia University and pursued an undergraduate degree at Duke University. David Joslin also sits on the board of InSight Radiology Puerto Rico.
In his current role as a healthcare consultant, David Kent Joslin advises companies in developing a competitive strategy, identifying growth, and pursuing value-additive mergers and acquisitions. David Joslin describes growth in M&A activity over the last several years as being strong across all transaction sizes increasing by 14.4 percent from 2017 into 2018 with continued momentum into 2019.
In this article he has identified several trends driving M&A activity in the first half of 2019 and provides several indicative transactions:
Clinical / Patient Data Management: As the fee-for-service model continues to erode, data is becoming increasingly important in the delivery and monitoring of clinical care pathways for patients. From a corporate perspective, technologies that exploit big data analytics can drive improvements in operating efficiencies, investment decisions, personnel management, and regulatory compliance. Important recent acquisitions include:
- Beacon Health Options, a premier provider of behavioral health solutions to health plans, employers and labor organizations of all sizes
- Equian, a payments processing services provider for healthcare companies and insurers
- Press Ganey, a provider of safety, quality, patient experience, and workforce engagement solutions for healthcare organizations
- Vyne, a leader in secure health information exchange and electronic healthcare communication management for dental practices, hospitals, and major health systems
- Accumen, a tech-enabled provider of health system performance optimization solutions
- PatientsLikeMe, the world’s largest personalized health network that helps patients discover new treatment options
Prescription Drug Pricing and Medication Adherence: There has also been particular interest in bringing technology to the pharmacy piece of the healthcare continuum in terms of pricing, medication dose adherence, and transparency. Important recent acquisitions include:
- RX-Net, an automated, single interface, multi-location prescription price management for retail pharmacies
- Echo, a U.K.-based medication management company that enables patients to receive medication refill alerts in conjunction with at-home delivery
- Comprehensive Pharmacy Services, which addresses the challenges faced by hospitals and health systems in the form of drug cost inflation and retail/specialty pharmacy strategy and operations
Revenue Cycle Management (RCM) and Payment Solutions. Healthcare services providers are increasingly dependent upon third-party technology providers to facilitate operational efficiencies and overcome pressing financial and operational hurdles. Challenges to a provider’s goal of maintaining market competitive advantage have come in the form of regulatory change, greater patient choice, and sophistication, shifting payment models. Important recent acquisitions include:
- McBee, a leading technology-enabled revenue cycle management, strategic consulting and other professional services firm that serves providers in acute and post-acute care settings
- Ensemble, which markets an outsourced, hospital-focused revenue cycle management platform
- InstaMed, a leading healthcare technology company that has developed a paperless healthcare payments solution with particular focus on improving the consumer financial experience and reducing the cost of collecting payments
Remote Patient Monitoring. Healthcare providers recognize the importance of maintaining the continuity of longer-term multi-dimensional care for patients with chronic conditions who are between doctor’s office visits. Such technologies improve outcomes, reduce healthcare spend, and improve patient quality. Important recent acquisitions include:
- Critical Signal Technologies, a leading provider of remote real-time patient monitoring and care services in conjunction with an emergency response capability
- Tueo Health, a patient monitoring solution that monitors nighttime sleep breathing of children with asthma
Home Health / Hospice. Closely associated with developments in remote patient monitoring (noted above) is the increasing reliance by providers on the provision of care in the home to aging patients with high-cost, medically complex ailments. Payors have welcomed this development since in many cases the quality of care can be improved alongside a dramatic reduction of cost. Important recent acquisitions include:
- AccentCare, a Dallas-based provider of post-acute services in rehabilitative therapy and hospice with a presence in 16 states
- Forever Young Home Care, a provider of companionship, homemaking duties, transportation, meal preparation, medication reminders and full personal care throughout NC and GA
- Alacare Home Health & Hospice, an operator of home health and hospice with 23 locations in Alabama
- Mission Healthcare, a home health and hospice services provider for its California patients
Healthcare Staffing Solutions. Growing patient demand and increasing complexity of healthcare treatment pathways have created an urgent need for service providers to maintain and/or have ready access to excess capacity in terms of service offering breadth and depth. The lack of such capacity results in sub-optimal care treatment and diminished patient satisfaction. Important recent acquisitions include:
- Symmetry Healthcare Solutions, a platform that aggregates 100+ qualified healthcare staffing agencies including travel nurse, locums, and just-in-time local staff
- CV Staff Solutions, which focuses on cardiovascular surgeons, cardiologists, and non-physician providers for inpatient care facilities
A long career as a senior executive in finance and radiology, both in the U.S. and abroad, prepared David Joslin for his latest occupation as a consultant specializing in mergers and acquisitions and general management advisory.
Although he’s not a medical doctor, David Joslin has accumulated a trove of knowledge about radiology and the radiology business.
David Joslin has also worked as a radiology consultant and continues to stay involved in the radiology business today as a longtime member of the board of directors for a leading radiology healthcare services provider in Puerto Rico.
David Joslin has witnessed a fundamental change in the industry and he explains how the field has evolved. “Today radiology has become an IT-driven business with a technological at its core that facilitates a three-way interactive dialogue between referring physician, diagnosing radiologist and the patient”, Joslin said. He continues, “A third component in the form of a central radiology backbone, called RIS/PACS in industry parlance, stands equally alongside the radiologist and the imaging machines themselves in importance to getting the diagnosis right. Broadly speaking, RIS/PACS coordinates image capture, interpretation, and storage as well as key business functions such as patient scheduling, insurance billing and the production of KPIs (key performance indicators) to give managers hard data with which to make decisions.”
Radiology is a medical specialty that diagnoses disease and detects tissue or bone abnormalities by seeing or visualizing those medical conditions in the body which in turn guides better treatment decisions. Before radiology, without the ability to visualize, medical intervention relied more heavily on less direct methods of diagnosis.
After the discovery of x-rays in 1895, physicians learned how to transmit them through the body in order to produce an image, or radiograph, of internal bone or tissue structure. Improvements in that technology first resulted in fluoroscopy, which captured motion instead of still x-ray images.
The advent of computing made possible further advances in imaging of tissue structure and function including computed tomography (CT), dynamic ultrasound imaging based on sound wave technology, and magnetic resonance imaging (MRI), among others, which relies on the magnetic properties of fluids in the body and tissue. Imaging of body chemistry has been achieved through a combination of positron emission tomography and CT (PET/CT) which together track the properties and behavior of radioactive agents introduced into the bloodstream.
Radiology Aids the Cure
Whether they are general practitioners or board-certified surgeons, doctors around the world today rely on radiology to diagnose, treat and heal injuries, ailments, and diseases from head to toe.
A shortlist of some of the different types of radiology today includes:
· Body imaging
· Breast imaging (mammogram)
· Cardiac imaging (heart)
· Interventional radiology (includes biopsies)
· Musculoskeletal imaging (joints, muscles, ligaments, tendons, and bones)
· Neuroradiology (brain)
· Nuclear medicine
· Pediatric imaging (children)
· PET/CT imaging (positron emission tomography/computed tomography)
· Thoracic imaging (spinal and cervical)
· Vascular imaging (blood vessels, arteries, and veins)
After graduating from Duke and earning an MBA from Columbia in 2001, David Joslin worked in investment banking before taking executive positions in connection with investments in the healthcare space, namely healthcare services, and medical devices.
In 2002, Joslin was a co-founder and served as a strategy and operations executive for InSight Radiology, a chain of outpatient radiology facilities in San Juan, Puerto Rico. Six years later, he left the company but returned from 2012 to 2015 to serve as its president and he continues to serve on the company’s board of directors today.
From 2008 to 2012, in between his stints at InSight Radiology, David Joslin returned to New York to serve as vice president of mergers and acquisitions at Alliance Healthcare Services, where he created and led a mergers and acquisitions group at the large radiology center operator and cancer treatment provider, completing five transactions with a total equity value of $102 million.
Later, from 2016 to 2017, Joslin was vice president of operations and development at RadNet, where he managed operations for 17 radiology centers in New Jersey. He was responsible for a $65 million profit and loss portfolio.
David Kent Joslin currently advises companies in identifying and resolving issues inhibiting growth in order to create a strategic competitive advantage. Joslin’s strategic insight and hands-on operational experience, along with financial, capital raising and accounting expertise, combine to provide his management clients with balanced and actionable advice.
For more information about David Joslin’s career as a radiology consultant and list of selected transactions in mergers and acquisitions, capital markets and licensing, click here.
Radiology consultant David Joslin is a senior executive with demonstrated results in corporate strategy and development, mergers and acquisitions, de novo (facility development) projects, operations, turnarounds, partnerships, accounting and financial management.
Based in Sarasota and with an international reach – he has long worked in Puerto Rico and has business proficiency in Spanish – David Joslin has parlayed his education, international banking experience and intimate knowledge of healthcare services, software development, media, investment banking and management consulting to compile an impressive career resume.
David Kent Joslin currently advises companies in identifying and resolving issues inhibiting growth in order to create a strategic competitive advantage. Joslin’s strategic insight and hands-on operational experience, alongside informed financial, capital raising and accounting expertise learned at several investment banks, combine to provide management with balanced and actionable advice.
After Duke, International Insights
After graduating from Duke University in 1993 with a joint degree in history and political science, David Kent Joslin went international for his first real job, becoming a strategy management consultant for a leading media and telecom company based in Mexico City.
Then it was on to London in 1996-97 as a financial analyst for an international investment banking firm and later to Columbia Business School in New York with a summer internship with Bain Consulting in 2000, this time in Panama City, Panama.
Earned an MBA from Columbia
After earning his MBA from Columbia in 2001, David Joslin stayed in New York at a large investment bank after which he teamed with several angel/venture investors to make start-up investments in healthcare services and medical devices, InSight Radiology and CAD Sciences, respectively. Both investments had David Joslin shuttling between New York and San Juan, Puerto Rico serving actively in management and as a board member.
David Joslin returned to New York in 2008 to serve as vice president of mergers and acquisitions at a large radiology and cancer treatment healthcare services firm, before returning to InSight from 2012-2015. Later, as vice president of operations and development at RadNet from 2016-17, Joslin managed operations for 17 radiology centers in New Jersey, where he had P&L responsibility for a $65 million radiology services operation.
At Home in Sarasota
A Tough Mudder enthusiast, David Kent Joslin also is interested in current history and enjoys golf and cycling, as well as spending time with his family in beautiful Sarasota. He often travels to New York and holds a real estate license in that state.
For more information about David Kent Joslin’s professional career and a more detailed list of his successful mergers and acquisitions, click here.